Last updated: July 22. 2014 7:09PM - 843 Views
By - acloud@civitasmedia.com



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On Monday, representatives from WellCare released a statement to the Daily News in reference to some allegations made by local hospital CEOs during State Auditor Adam Edelen’s forum for rural hospitals. WellCare refuted statements made regarding re-credentials and preauthorization claims.


“In accordance with the U.S. Government’s Centers for Medicare & Medicaid Services (CMS) requirements, we re-credential our providers once every three years and notifications start at least four months ahead of the deadline,” said Kelly Munson, state president, WellCare of Kentucky.


Munson also said hospital-based physicians, such as emergency room doctors, are not credentialed by health plans but are credentialed by the facilities they serve.


During the forum last week, Middlesboro ARH CEO Michael Slusher said it was common practice for WellCare to simply decide to require physician groups to re-credential with little to no notice. He said this resulted in the emergency department having no physicians credentialed with WellCare one weekend about a month ago.


Munson said they are also required to notify providers about preauthorization changes a minimum of 30 days in advance.


“We do not require a preauthorization for emergency services, and many factors are considered when evaluating the coverage for emergency services,” said Munson. “Our practices are guided by rules and regulations, as well as our strong commitment to be our providers’ partner of choice.”


In regards to preauthorization changes, Slusher said it’s common practice for services not on the preauthorization list to suddenly appear on the list with little notice.


“We could in good faith thought we were providing a service that didn’t require preauthorization. Suddenly now, according to the third party payer, it does require preauthorization and they deny payment,” said Slusher during the public forum last week.


In the emailed response, Munson said WellCare takes pride in caring for their members and truly values their provider relationship.


“We work hard to ensure that our administrative processes enable timely access to care for our members and reimbursements to our providers,” said Munson.


Anthony Cloud can be contacted at 606-302-9090 or on Twitter @AnthonyCloudMDN.


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